Enter the number of students you wish to enroll next to the applicable program.
Please answer the following questions as completely as you can. If you run out of room or have difficulties with this form, call us at 1-800-595-2630 between 8 and 5 PST, or email at orion@nas.com
Student's full name
Student's Social Security number
Student's Address
Student's Phone#
Student's Fax # (if available)
Date of birth:
Male or female?
Student's Nationality (optional)
Student's Immunization Status
Grade Level as of today:
Estimated graduation date (mo/yr):
Name of previous school
Previous school address
City, State, and Zip code
Will student dual school?
Do you intend to earn a diploma from ALC?
Do you have any siblings currently enrolled with Alger Learning Center? If so, who? If "yes", note that this discount will not show up on your email receipt, but it will be applied at time of billing
Please list areas of interests:
Does this student have any learning differences? If so, please list them.
Will student have access to a computer?
Student's Email
Name of male parent/guardian, address, home and work telephone numbers, and occupation
Male parent/guardians educational background
Name of female parent/guardian, address, home and work telephone numbers, and occupation
Female parent/guardians educational background
Referred by:
If transfering, why is student transfering from his/her previous school? Briefly explain
Has the student ever been expelled? If yes, briefly explain.
Has the student/family had any experience with homeschooling/independent learning? If yes, briefly explain
Does the student have any allergies or any other medical conditions which ALC/IHS staff should be aware of?
Is this student currently under doctor supervision or taking any medication?
Does this student have specific post-graduation plans? Are they planning on going to a community college or four-year university after graduating? Please explain briefly
Does this student plan on transfering credits to another elementary, middle, or high school?
Emergency Information Please supply someone to contact in case of emergency. Include name, work and home numbers, and the relationship to the student.